Vaginal Dinoprostone controlled release pessary (Propess)

Vaginal Dinoprostone is given in the form of a flat tampon pessary (Propess) that is inserted into the vagina and placed behind the cervix (neck of the womb). This can be done on ANDU, the Antenatal Ward or the Birthing Centre. This pessary slowly releases vaginal dinoprostone and will remain inserted for 12-24 hours to try and start your labour spontaneously or to get you to a stage where it would be possible to break the waters around your baby. This is called Artificial Rupture of the Membranes (ARM). 

Once the pessary is in place, you will be advised to lie down for a short time to allow the tampon to swell inside your vagina and reduce the chance of it coming out when you are at home. The string of the pessary will be visible outside of your vagina. For this reason, it is important to take care when you wipe yourself after going to the toilet, washing and when getting on and off the bed, that the string is not dislodged, as this will pull the pessary away from the cervix (neck of the womb), thereby reducing its effectiveness.

If you are suitable for outpatient induction, you will be allowed to return home and come back to the hospital 24 hours later. The pessary needs to stay in place until you return to the hospital. Before giving Propess the midwife will monitor your baby’s heartbeat with an electronic fetal heart rate monitor (CTG).  You will be advised to rest on the bed for 30 - 60 minutes afterwards to allow absorption of the vaginal dinoprostone and monitoring of the fetal heartbeat.  Once it is established that everything is okay, the CTG will be discontinued and you will be able to move around, we encourage you to move around as this will help the induction process.

If everything is satisfactory and you have no further questions, then you will be able to go home to continue with your day-to-day activities.

On rare occasions it may be necessary to delay starting your induction to ensure that a midwife is available and that the unit has the space to provide the care you require safely. We will do our best to ensure that delays are kept to a minimum and that you are kept informed.

Very occasionally vaginal dinoprostone can cause the uterus to contract too much which may affect the pattern of your baby’s heartbeat.  If this happens you will be asked to lie on your left side, the Propess will be removed and you may be given other medication to help relax your uterus (womb) and we will monitor your baby's heartbeat.

At home

Whilst at home you can continue to eat and drink as usual and carry on with your usual activities. You will be advised to contact the Maternity Assessment Unit on 01226 432249 immediately if:

• you start having regular tightening (contractions)
• you think your waters have broken
• you have any red vaginal bleeding and/or your baby is not moving as much as it usually does
• the pessary falls out
• you are worried or have any questions

What to expect

The pessary works by getting the cervix (neck of the womb) ready for labour. This process means that the cervix will soften, shorten and begin to open. It is not uncommon to feel a period type pain whilst this process is happening. If you are managing at home with pain relief medication such as paracetamol or codeine then you can stay at home whilst this is happening. Often, gentle exercise such as walking, use of a birthing ball, massage or warm showers may help at this stage.

If you are distressed, not managing with the pain or feel the contractions are 5 minutes apart, then you should call the maternity triage department who will advise you further whether you should come to the hospital.

There is a small chance that you may be very sensitive to the pessary. Contact the maternity triage department for advice if:

• you experience contractions
• you experience contractions that are frequent and last a long time without a break in between
• you experience severe abdominal pain
• you have any other concerns

What happens after 24 hours?

You will have an appointment to return to the hospital 24 hours after your Propess pessary was inserted to have it removed and to continue with the induction of labour process.

On admission you will have a vaginal examination to assess whether the cervix (neck of the womb) has begun to open. If, on examining your cervix, the midwife finds it has dilated but labour has not yet begun, the next step in the process will be to have the membranes around your baby (your waters) broken artificially. This is performed on the Birthing Centre, where a midwife is allocated to provide one-to-one care for you in labour. This will not cause any harm to your baby, but the examination may cause you some discomfort. Following this, if labour is slow to begin it may be necessary to start a hormone drip called Oxytocin (Syntocinon) in order to help your labour progress.

If, on examining your cervix, the midwife finds it hasn’t dilated enough to have the membranes around your baby broken, you will be offered Dinoprostone (Prostin).